Provider Demographics
NPI:1851522882
Name:CIRERA-PROBST, MARISKA RIVERA (OD)
Entity type:Individual
Prefix:DR
First Name:MARISKA
Middle Name:RIVERA
Last Name:CIRERA-PROBST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3207
Mailing Address - Country:US
Mailing Address - Phone:503-221-6539
Mailing Address - Fax:
Practice Address - Street 1:524 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3207
Practice Address - Country:US
Practice Address - Phone:503-221-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3325AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist